Current status of health insurance card, the demand situation and the ability to meet the health care needs for people living with

HIV receiving antiretroviral treatment in Hanoi in 2012.

4.2.1. Current status of health insurance for people with HIV / AIDS are on ARV.

The percentage of patients with health insurance cards is 13.6%, this figure is very low compared to the percentage of people participating health insurance Hanoi city is 68.91% in 2013. The reason for the disease people do not buy health insurance is afraid to be identified "Buying health insurance is scared of being identified missed,

why because of medical or health insurance card they ask this bottle"

26 male patients, fear of troublesome "troublesome procedures to buy health insurance is a household, people's identity card and must be purchased in wards have been the household registration system, visit the waiting drugs less, there is much room discrimination keeps people have health insurance card, and the person does not have health insurance "32 female patients years old, had no money and did not deem it necessary "My family said it's also difficult to 100,000 VND how few hundred thousand to buy the card, health insurance card renewal examination and the patient just sneezing runny nose, so I do not buy" 28 female patients fresh. Understanding health insurance was not correct "They understand about health insurance is not right here we will strengthen advocacy for health insurance and training to patients about health insurance" OPC officials Tay Ho.

4.2.2. Needs and status and needs medical care of HIV / AIDS on ART.

4.2.2.1. Demand and the state of medical care of HIV / AIDS on ART.

Ignorance, not equipped with the knowledge about HIV / AIDS and issues related to HIV / AIDS adequately, lack of information is a cause of deep impede people living with HIV / AIDS to the health care service. Needs, wishes to provide the knowledge, up to 95.3% of people living with HIV / AIDS are on ARV saw demand and this percentage is much higher compared to studies in Brazil is the need provided demand knowledge of ARVs accounted for 68.2% of patients are needed, and only 0.5% felt less necessary. According to study results, only less than 5% is not answered and saw no need to supply and lower results compared to studies in Brazil 12.3% of patients do not want to know any what. Proportion of providing knowledge to patients in outpatient clinics accounted for 90.6% of doctors are much higher compared to studies in Brazil is 70.8% and is much higher than researchers Ha Thi Minh Duc, Le Vinh was 56.4%. In the study by Ha Thi Minh Duc, Le Vinh, there are 45 patients (23.1%) said they obtained information through magazines, 38 (19.5%) is through television. In the study by the authors at a hospital in Brazil, it shows that out of 195 respondents, 110 (70.8%) received information from the doctors at the start of treatment.

The proportion of patients to receive information from your doctor is highly suitable for ARV patients are doctor periodic health checks and medicine 1 month / 1 times. However, despite the electronic media (internet, television), the groups and associations that affect health but experts still seems to be the safest source of reliable and largest of the information medicines for patients. HIV-infected people need to have a diet, adequate nutrition can improve conditions create highly effective antiretroviral treatment, however, the poverty rate in this group of high-nutrition should support them as necessary however, only 552 patients (16.2%) is nutritional support workers mainly received by artifacts such as rice, oil, milk 84.5%. The number of people receiving cash assistance only 3.41%. This rate is much higher than the study of Tran Bich Tra and colleagues.

The study results also showed that the model club activities / self-help groups of people living with HIV / AIDS are still not widespread, there is little activity OPC Club / self-help groups of people living with HIV / AIDS and there are fewer people with HIV / AIDS known the existence of this business model. When answering the questions:

Outpatient Clinic where he / she treated with CLB / self-help groups do? 2117 people there were pretty high percentage 63.14% of the total 3353 respondents to this question said they "do not know", only 657 people proportion 19.59% reported to have said the club / self-help groups are active. However support job training and career counseling suitable job placement for people with HIV / AIDS are treated in the OPC in Hanoi really has not been met there are currently no other organization was up to guide vocational training and job placement suitable for people with HIV / AIDS.

Other services the patient will have to pay health insurance is so essential to the patient. According to a discussion group, subjects said

"health insurance for everyone, it is important for HIV-infected people is even more important because it is needed to serve partially paid medical care, he was serious illness will be hospitalized, will be somewhat better, should have supported advocacy organization for health insurance help "_ 30-year-old female patient

4.2.2.2 Ability to meet the health care needs of people living with HIV / AIDS on ARV treatment in outpatient clinics

An assessment of the needs to be provided with knowledge: the 3,379 respondents, only 27.94% to reach 21 points or more and are rated up to meet the demand for knowledge. In particular, the number of outpatient clinics Dong Da district health centers have the hit rate on the ability to meet the greatest knowledge (38.46%). The rate reached about the ability to satisfy the lowest knowledge in Ba Vi district health centers (11.63%) lower than the study of Ha Thi Minh Duc (practical knowledge about ARV adherence HIV / AIDS outpatient clinics in district 10, Ho Chi Minh city in 2009) share the true knowledge about compliance with antiretroviral therapy 69% of patients in which correct knowledge about side effects of medicines of 64% , the proportion of patients with the right knowledge on how to take medication and medication on time to reach> 99%.

An assessment of the needs nutritional support: in 3379 respondents, only 13.02% scored 8 or more and are rated up to meet nutritional needs. In it, the clinic Bavi completion rate on the ability to meet the greatest nutrition (25.59%) is lower than the demand for nutritional support: 44% in the study by J Uwimana (at Ruwanda).

Assess the needs assistance with medical care: the 3,379 respondents, only 37.35% scored 8 or more and are rated up to meet the demand for medical care. In particular, hospital outpatient clinic with 09 hit rate on the ability to meet the health care is the largest (51.20%), lowest in Ba Vi district health centers (23.26%) compared with the model US Medicaid 50% of patients with HIV / AIDS and 90% of adult children living with HIV / AIDS in the United States are receiving care Medicaid program and other 5% of patients receiving medical care, the study lower.

An assessment of the needs of social assistance: Education deeply affects the ability to effectively meet the needs of social care for people with HIV / AIDS. Low education levels are predictive factors that limit people with HIV / AIDS access to and use of social care services, self-stigma, fear, self-isolate themselves makes people

with HIV / AIDS conceal illness, low self-esteem did not dare to face the life was made for people with HIV / AIDS do not have enough courage and confidence to come to the social care services.

There is a difference of assessment to meet the needs of social care between the patient groups according to level of education.

Education group graduated from high school and older are to meet the needs of higher social care groups have low levels of education have not graduated from high school. In the 3379 interview participants in the study results (17.90% only reached 12 points or more and is judged to be on the needs of social care. In particular, outpatient clinics health center bar spring is the proportion of patients assessed for care, social support was highest (29.11%); Next is Lung Hospital in Hanoi &

Hospital 09 (25% & 24.80%) and the proportion rated reaching the lowest price outpatient clinic Bavi district health center is only 6.98%) lower than that of Nguyen Van Kinh study.

This study have similarities in the relationship between knowledge, openness, with helpers and responsive health care, but another factor in the relation of sociology of population compared to studies Ha Thi Minh Duc (in patients with helpers in treatment, adherence rate higher than the corresponding rate in patients with no help, this difference was statistically significant with p = 0.03.

Relationship between adherence practice with ART: There is an association between nutritional practices (meal, vegetables, fruits of all kinds) with compliance with statistical significance with p <0 , 05, prevention counseling during antiretroviral therapy helps Patients recognize the need for continuous treatment to prolong life.

4.3. Evaluate the effectiveness of interventions to support health